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Background: Type 2 diabetes (T2D) is a common and serious chronic debilitating disease. Until recently, type 2 diabetes has been typically regarded as a disease of the middle-aged and elderly. While this age group still maintains a higher risk than younger adults, evidence is accumulating that onset in those under 30 years is increasingly common. Type 2 diabetes and its complications constitute a major public health hazard affecting people in both developed and developing countries. Prevalence of type 2 diabetes has been increasing exponentially, across the World. Multiple risk factors of diabetes, delayed diagnosis, life-threatening complications, sub-therapeutic treatment, and higher treatment costs are some crucial barriers to the control of type 2 diabetes. Aim of the Study: This study aimed to assess the risk factors of T2D in 1st-year MBBS and BDS students of North East Medical College (NEMC), Sylhet, Bangladesh. Methods: This was an observational crosssectional study undertaken at the Endocrine Outpatient Department in a Tertiary Care Hospital, Sylhet, Bangladesh, during the period from November 2017 to February 2018. Non-probability purposive sampling was done. Out of 145 MBBS and BDS students who got admitted in session 2017-2018, data of 143 students were included as a part of regular medical checkup after permission of the concerned authority. As applicable, all data were expressed as frequencies and mean ±SD or mean ±SE. Student’s t-test and Chi-square test were conducted where the p-value <0.05 was considered significant. Data analysis was done using computer-based SPSS version-22.0. Results: Among the total of 143 participants, 36.8% were female, and the male-female ratio was 1:1.7. Among all of them, 53% belonged to the 17-20-year age group whereas the rest 47% belonged to the 21-22-year age group. In analyzing the association of risk factors among participants we observed that the highest number of participants was associated with a family history

A 72-year-old man was admitted to the hospital with fatigue. Colonoscopy revealed a 50 × 50mm rectal tumor with bleeding. Based on close inspection, he was diagnosed with unresectable advanced rectal cancer with multiple liver metastases. Chemotherapy was administered as 10 cycles of bevacizumab + mFOLFOX6 and 7 cycles of bevacizumab + FOLFIRI. Nine months later, he presented with hematochezia and progression of anemia. It was difficult to stop the bleeding via endoscopy. He underwent radiation therapy (39Gy in 13 fractions), and hemostasis was confirmed. Then, further chemotherapy was performed with 3 cycles of bevacizumab + FOLFIRI and 2 cycles of TAS102. However 14months after the initial visit, he presented with right hypochondralgia and abdominal fullness due to the progression of multiple liver metastases. Palliative low-dose whole-liver radiation therapy (WLRT) (30Gy in 10 fractions) was performed. He developed Grade 2 nausea, but his right hypochondralgia reduced, liver dysfunction improved, and he successfully completed radiotherapy. At approximately the same time his anemia progressed, and colonoscopy revealed recurrent bleeding from the tumor. Re-irradiation (15Gy in 5 fractions) of the rectal tumor was carried out and a blood transfusion was performed for the bleeding. He was discharged after confirmation the anemia had not progressed. Few reports have been published on the use of both palliative re-irradiation to stop bleeding from rectal cancer and palliative low-dose WLRT. Based on our experience with this case, we believe that palliative radiotherapy can be useful in treating patients with a poor prognosis.

The primary choice among treatment options for liver malignancies is surgery. However, if surgery cannot be performed, Stereotactic body radiotherapy (SBRT) may be effective. 99m-technetium galactosyl human serum albumin (GSA) single-photon emission computed tomography (SPECT) imaging is useful for the assessment of liver function before surgery. We report the case of a 77-year-old man who had undergone SBRT for hepatocellular carcinoma of the left lobe of the liver 2 years previously. Follow-up revealed a 15-mm hepatocellular carcinoma at the edge of the right lobe of the liver. 99m-technetium GSA SPECT was performed before SBRT to confirm that there was no accumulation in the left lobe and to ensure that there was good function of the right lobe. Three months after SBRT, the tumor had responded, and decreases in GSA accumulation were observed in line with the radiation beam. Because hepatocellular carcinoma often relapses, it is important to assess the anatomic site of liver dysfunction before and after radiation. This case demonstrates that 99m-technetium GSA SPECT is useful for this purpose., source:https://www.sciencedirect.com/journal/radiology-case-reports, source:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823782

source:https://link.springer.com/article/10.1007/s12029-018-0138-8

source:https://link.springer.com/article/10.1007/s12029-017-9994-x

There are several reports that vouch for the usefulness of diffusion-weighted image (DWI) in making a diagnosis before treatment. However, no study has evaluated the effect of radiotherapy (RT) for unresectable gastric cancer. In the present case report, we evaluated the effectiveness of RT using DWI. An 81-year-old man was hospitalized with a broken bone and then diagnosed with advanced gastric cancer with breeding. He had chorionic renal failure and surgery was impossible. Further, contrast-enhanced computed tomography and magnetic resonance imaging (MRI) were not performed due to renal failure, whereas palliative RT was performed. We followed up the patient using blood test and MRI (DWI) to estimate whether bleeding had stopped or not after radiotherapy. Hemostasis effect was found after 2 weeks of RT. In DWI examination, there was a decrease in the tumor signal intensity 30days after RT. Similarly, at day 60, the tumor signal intensity further decreased on DWI and the blood test results indicated no progression of anemia. At 4months after the RT, the patient died because of respiratory failure without any bleeding. DWI is useful not only for the initial diagnosis but also for evaluating the effectiveness of RT.Trial registration: National clinical study registered number: UMIN000026362., source:https://link.springer.com/article/10.1007%2Fs12328-018-0923-8

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Fabrication and characterization of flexible optical fiber bundles (FBs) with in-house synthesized high-index and low-index thermally matched glasses are presented. The FBs composed of around 15000 single-core fibers with pixel sizes between 1.1 and 10 mu m are fabricated using the stack-and-draw technique from sets of thermally matched zirconium-silicate ZR3, borosilicate SK222, sodium-silicate K209, and F2 glasses. With high refractive index contrast pair of glasses ZR3/SK222 and K209/F2, FBs with numerical apertures (NAs) of 0.53 and 0.59 are obtained, respectively. Among the studied glass materials, ZR3, SK222, and K209 are in-house synthesized, while F2 is commercially acquired. Seven different FBs with varying pixel sizes and bundle diameters are characterized. Brightfield imaging of a micro-ruler and a Convallaria majalis sample and fluorescence imaging of a dye-stained paper tissue and a cirrhotic mice liver tissue are demonstrated using these FBs. demonstrating their good potential for microendoscopic imaging. Brightfield and fluorescence imaging performance of the studied FBs are compared. For both sets of glass compositions, good imaging performance is observed for FBs, with core diameter and core-to-core distance values larger than 1.6 mu m and 2.3 mu m, respectively. FBs fabricated with K209/F2 glass pairs revealed better performance in fluorescence imaging due to their higher NA of 0.59., Smart Growth Operational Programme; EU-H2020-ICT-2014 grant MIREGAS: Programmable multi-wavelength Mid-IR source for gas sensing; Foundation for Polish Science Team Programme; European Regional Development Fund; European Union (European Union); H2020

Background/aims: the anastomotic strictures are one of the most common colorectal surgery complications, and various endoscopic techniques have been defined. Balloon dilation is the most well-known and the simplest procedure. In this article, we aimed to present our series of endoscopic interventions and electroincision management for anastomotic strictures. Materials and methods: the files of 59 patients, who underwent colorectal surgery between January 2010 and September 2017 in our hospital and were diagnosed during the follow-up with anastomotic stricture, were analyzed. The outcomes of endoscopic interventions such as balloon dilation and electroincision were compared and reported. Results: the mean age of the 59 patients included in the study was 59.5 +/- 16.26 years. The primary operative indications were colorectal cancer in 46, inflammatory bowel disease in 7, diverticulum in 5, and penetrating trauma in one patient. Single- or multiple-balloon dilations were successful in 48 patients. Electroincision was performed in 11 patients because of the balloon dilation failure. None of the patients needed a secondary surgery. During the mean 33.75 months of the follow-up, the stricture recurred in seven patients who had undergone balloon dilation. Repeated balloon dilation was successful in these patients without any need for an additional surgical intervention. Conclusion: balloon dilation can be performed safely as the primary treatment option, because of its easy access and noninvasive application. Electroincision is also a safe and effective endoscopic technique that can be preferred especially when the balloon dilation fails., NA

Non-alcoholic fatty liver disease (NAFLD) is caused by the imbalance between lipid deposition and lipid removal from the liver, and its global prevalence continues to increase dramatically. NAFLD encompasses a spectrum of pathological conditions including simple steatosis and non-alcoholic steatohepatitis (NASH), which can progress to cirrhosis and liver cancer. Even though there is a multi-disciplinary effort for development of a treatment strategy for NAFLD, there is not an approved effective medication available. Single or combined metabolic cofactors can be supplemented to boost the metabolic processes altered in NAFLD. Here, we review the dosage and usage of metabolic cofactors including l-carnitine, Nicotinamide riboside (NR), l-serine, and N-acetyl-l-cysteine (NAC) in human clinical studies to improve the altered biological functions associated with different human diseases. We also discuss the potential use of these substances in treatment of NAFLD and other metabolic diseases including neurodegenerative and cardiovascular diseases of which pathogenesis is linked to mitochondrial dysfunction., Knut and Alice Wallenberg Foundation

source:https://link.springer.com/article/10.1007%2Fs12029-017-0026-7

source:https://link.springer.com/journal/12029

В статье приведены данные о роли печени в углеводном и липидном обмене, описаны особенности метаболизма глюкозы в условиях инсулинорезистентности и роль глюкокиназного пути поступления глюкозы в гепатоцит. Освещены результаты экспериментальных и клинических исследований влияния биотина на обмен глюкозы, липидов, аминокислот и возможности его использования в лечении больных неалкогольной жировой болезнью печени., У статті наведено дані про роль печінки у вуглеводному та ліпідному обміні, описані особливості метаболізму глюкози в умовах інсулінорезистентності та роль глюкокіназного шляху надходження глюкози в гепатоцит. Висвітлені результати експериментальних та клінічних досліджень щодо впливу біотину на обмін глюкози, ліпідів, амінокислот та можливості його використання в лікуванні хворих на неалкогольну жирову хворобу печінки., The article presents data on the role of the liver in carbohydrate and lipid metabolism, describes glucose metabolism features in insulin resistance and the role of glucokinase pathways of glucose uptake in the hepatocyte. The results of experimental and clinical studies of the effect of biotin on metabolism of glucose, lipids, amino acids, and the possibility of its use in the treatment of patients with nonalcoholic fatty liver disease were considered.

Primary sclerosing cholangitis (PSC) is particularly common in the Nordic countries. Most (70-80%) PSC patients have concomitant inflammatory bowel disease (IBD). The majority of patients are male. Increased levels of serum cholestasis markers in IBD patients lead to PSC suspicion, and diagnosis is verified with magnetic resonance cholangiopancreatography or endoscopic retrograde cholangiography (ERC). PSC patients usually become symptomatic over time, and PSC may lead to liver fibrosis and finally to cirrhosis. Cholangiocarcinoma (CCA) develops in 7-13% of PSC patients. The prognosis of CCA is poor. Dysplasia of the bile ducts is thought to precede the development of CCA. Liver transplantation (LT) may be performed in end-stage PSC cirrhosis, but premalignant biliary changes may also be a partial indication for LT even if the patient is asymptomatic. At Helsinki University Hospital, PSC patients regularly undergo systematic dysplasia surveillance with ERC and brush cytology (BC) to detect dysplastic changes of the bile ducts and to determine disease progression. ERC changes are graded according to the modified Amsterdam ERC score. If suspicion of dysplasia is repeatedly seen in BC, patients are referred to liver surgeons for consideration of LT. Our aims were to evaluate the relevance of the screening protocol at PSC diagnosis and later during the disease course to identify risk factors for biliary neoplasia, and to evaluate the utility of ERC, BC and ploidy analysis of biliary epithelium in detecting biliary neoplasia. In their first, diagnostic ERC (n=261), 81% of PSC patients were asymptomatic, but 43% already had advanced ERC changes. Seven percent had malignancy or malignancy suspicion in BC. Those who had elevated liver enzymes and advanced ERC changes were most likely diagnosed with biliary neoplasia during follow-up. Female patients had milder ERC changes and a lower cumulative risk of biliary neoplasia. During the follow-up period (median 4.7 years), 2.7%, Primaarinen sklerosoiva kolangiitti (PSC) on erityisen yleinen Pohjoismaissa. Useimmilla PSC-potilailla on myös tulehduksellinen suolistosairaus. Kolestaattisen potilaan PSC-diagnoosi varmistetaan magneettikolangiografialla tai endoskooppisella retrogradisella kolangiografialla (ERC). PSC voi johtaa maksakirroosiin, ja lisää kolangiokarsinooman riskiä. Elinaikainen kolangiokarsinooman riski PSC-potilailla on 7-13%, ja jopa puolet kolangiokarsinoomista todetaan jo diagnoosivaiheessa. Sappitiehytdysplasiaa pidetään kolangiokarsinooman esiasteena. Kirroosivaiheen PSC:n hoitona käytetään maksansiirtoa, mutta myös sappitieneoplasian epäily voi olla indikaatio maksansiirrolle. Helsingin yliopistollisessa sairaalassa PSC-potilaille tehdään diagnoosivaihessa systemaattinen seulonta sappitieneoplasian löytämiseksi ERC:n yhteydessä otettavalla sytologisella harjanäytteellä sappiteistä. ERC:n avulla tutkitaan sappiteiden ahtaumia ja määritetään taudin vaikeusaste. Samassa yhteydessä otetaan myös näyte ploiditeettianalyysia varten edennyttä PSC:tä sairastavilta. ERC-muutokset luokitellaan modifioidulla Amsterdam-luokituksella. Tutkimuksessa todettiin, että diagnoosivaiheessa 81% PSC-potilaista oli oireettomia, mutta 43%:lla oli ERC:n perusteella jo edennyt tauti. Seitsemällä prosentilla oli diagnoosivaiheen seulonnassa otetussa harjasolunäytteessä epäily sappitieneoplasiasta tai varma maligniteetti. Seurannassa (mediaaniaika 4.7 vuotta) todettiin kolangiokarsinooma 2.7%:lla potilaista ja sappitiedysplasia poistetussa maksassa 3.1%:lla potilaista. Diagnoosivaiheen maksan ulkoisten sappiteiden ERC-muutokset, epäilyttävä sytologia ja kohonnut ALAT-arvo olivat riskitekijöitä seurannassa todettavalle sappitieneoplasialle. PSC-potilaiden seurannassa (mediaaniaika 6 vuotta) 3.8%:lla todettiin kolangiokarsinooma ja 5.1%:lla sappitiedysplasia poistetussa maksassa. Kolangiokarsinooman riskitekijöitä olivat miessukupuoli, edenneet ERC-muutokset, kohonneet maksaentsyymit ja seerumin tuumor

Background: Extra-oesophageal reflux (EOR) may lead to microaspiration in patients with cystic fibrosis (CF), a probable cause of deteriorating lung function. Successful clinical trials of ivacaftor highlight opportunities to understand EOR in a real world study. Methods: Data from 12 patients with CF and the G551D mutation prescribed ivacaftor (150 mg bd) was collected at baseline, 6, 26 and 52 weeks. The changes in symptoms of EOR were assessed by questionnaire (reflux symptom index (RSI) and Hull airway reflux questionnaire (HARQ)). Results: Six patients presented EOR at baseline (RSI > 13; median 13; range 2-29) and 5 presented airway reflux (HARQ >13; median 12; range 3 to 33). Treatment with ivacaftor was associated with a significant reduction of EOR symptoms (P < 0.04 versus baseline) denoted by the reflux symptom index and Hull airway reflux questionnaire. Conclusion: Ivacaftor treatment was beneficial for patients with symptoms of EOR, thought to be a precursor to microaspiration., BBSRC; UK Government Technology Strategy Board Knowledge Transfer Partnership; Medical Research Council Clinician Scientist Fellowship

We describe 2 patients with diabetes mellitus, presenting with upper abdominal pain. Although imaging findings were consistent with acute pancreatitis (AP), serum amylase and lipase levels were within normal limits. In both the cases, the only identifiable diagnostic culprit was vildagliptin. This is the first reported case of vildagliptin causing AP clinically and radiographically without elevated serum pancreatic enzymes. In conclusion, even when serum amylase and lipase levels are normal, AP should be kept in mind when making a differential diagnosis of patients with diabetes mellitus who present with abdominal pain and take dipeptidyl peptidase-4 (DPP-4) inhibitors., NA

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After Helicobacter pylori was identified, and its relationship with peptic ulcer disease was exactly shown, the relationship of this bacterium with gastroesophageal reflux disease (GERD) gained momentum and discussions continue to this day. We reviewed the literature for the relationship between H. pylori and GERD. According to the existing data, there is no relationship between GERD and H. pylori presence. Successful eradication therapy does not have an impact on the emergence or exacerbation of GERD. However Barrett's esophagus and esophageal adenocarcinoma are less frequent, especially in the presence of CagA positive H. pylori infections. Longterm use of proton pump inhibitor (PPI) may have an impact on the development of atrophy and/or intestinal metaplasia in H. pylori positive patients; therefore, H. pylori eradication is recommended in patients that should use long-term PPI. As a conclusion, H. pylori screening and the eradication decision should be independent of GERD, except for patients that will use long-term PPI., NA

Gastroesophageal reflux disease (GERD), which is common in many communities, is associated with structural factors, eating habits, and the use of certain drugs. The use of such drugs can lead to the emergence of GERD and can also exacerbate existing reflux symptoms. These drugs can contribute to GERD by directly causing mucosal damage, by reducing lower esophageal sphincter pressure (LESP), or by affecting esophagogastric motility. In this article, we report our investigation of the relationships between GERD and medications within the scope of the "Turkish GERD Consensus Group." For the medication groups for which sufficient data were obtained (Figure 1), a systematic literature review in English was conducted using the keywords "gastroesophageal reflux" [MeSH Terms] and "anti-inflammatory agents, non-steroidal" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "acetylsalicylic acid" [MeSH Terms], "gastroesophageal reflux" [All Fields] and "estrogenic agents" [All Fields], "gastroesophageal reflux" [All Fields] and "progesterones" [All Fields], "gastroesophageal reflux" [All Fields] and "hormone replacement therapy" [All Fields], "gastroesophageal reflux" [MeSH Terms] and "diphosphonates" [MeSH Terms] OR "diphosphonates" [All Fields], "calcium channel blockers" [MeSH Terms] and "gastroesophageal reflux" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "nitrates" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "antidepressive agents" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "benzodiazepines" [MeSH Terms] and "hypnotic drugs" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "cholinergic antagonists" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and " theophylline" [MeSH Terms], and " gastroesophageal reflux [MeSH Terms] AND "anti-asthmatic agents" [MeSH Terms]. The studies were analyzed and the results are presented here., NA

Iron deficiency (ID) and iron deficiency anemia (IDA) are important signs of gastrointestinal (GI) hemorrhage. Therefore, the evaluation of the GI tract should be a part of the diagnostic protocol in patients with IDA. GI hemorrhage is not a disease but a symptom, which might have different underlying causes. ID and IDA have significant negative impacts on the life quality and work ability, and they may lead to frequent hospitalization, delay of discharge, and increased healthcare costs. Therefore, an optimal management of the disease causing GI hemorrhage should include iron replacement therapy, along with the treatment of the underlying condition. IDA in inflammatory bowel disease (IBD) has received particular attention owing to its high prevalence, probably due to a number of other factors such as chronic hemorrhage, reduced dietary iron intake, and impaired absorption of iron. Historically, in IBD and in patients with GI hemorrhage, the diagnosis and management of IDA have been suboptimal. Options for iron replacement include oral and intravenous (IV) iron supplementation. Oral iron supplementation frequently results in GI side effects, and theoretically, it may exacerbate IBD activity; therefore, IV iron supplementation is usually considered in patients not responding to or not complying with oral iron supplementation or patients having low hemoglobin concentration and requiring prompt iron repletion. The aim of this report was to review the diagnostic and therapeutic considerations of IDA in IBD and GI hemorrhage with a multidisciplinary group of experts and to formulate necessary practical recommendations., NA

NA

Objective This study evaluated the risks and outcomes of capsule retention during capsule endoscopy (CE) for investigating small bowel disease. Capsule retention is the most serious complication of CE. Methods Before CE, the gastrointestinal tract was evaluated for blockages with computerized tomography. Analysis of CE was made retrospectively. Results Capsule endoscopy was used to investigate obscure bleeding (90.2%; n=324) or other symptoms (9.8%; n=35). The capsule retention rate was 11/359 (3.1%); it was retained in a malignant lesion area (adenocarcinoma or melanoma) in two patients (18.2%), in the small bowel in an ulcerated area in five patients (45.5%), and in the oesophagus/stomach in four patients (36.4%) due to dysmotility. None of the patients had symptoms of obstruction. Conclusions Scanning patients before CE did not predict capsule retention. Retention is a complication of CE, but occurs as a result of the underlying disease. The risk of retention is increased in patients with motility disorders, suspected small bowel ulcers or malignancies., NA

Background: Chronic liver injury can lead to the development of liver fibrosis and cirrhosis but only in a minority of patients. Currently, it is not clear which factors determine progression to fibrosis. We investigated whether DNA\methylation profile as determined by pyrosequencing can distinguish patients with mild from those with advanced/severe fibrosis in non-alcoholic liver disease (NAFLD) and alcoholic liver disease (ALD). To this end, paraffin-embedded liverbiopsies were collected from patients with biopsy-proven NAFLD or ALD, as well as paraffin-embedded normal liver resections, genomic DNA isolated, bisulfite converted and pyrosequencing assays used to quantify DNA methylation at specific CpGs within PPAR alpha, PPAR alpha, TGF beta 1, Collagen 1A1 and PDGF alpha genes. Furthermore, we assessed the impact of age, gender and anatomical location within the liver on patterns of DNA methylation inthe same panel of genes. Results: DNA methylation at specific CpGs within genes known to affect fibrogenesis distinguishes between patients with mild from those with severe fibrosisin both NAFLD and ALD, although same CpGs are not equally represented in both etiologies. In normal liver, age, gender or anatomical location had no significant impact on DNA methylation patterns in the liver. Conclusions: DNA methylation status at specific CpGs may be useful as part of a wider set of patient data for predicting progression to liver fibrosis., EASL Physician Scientist Sheila Sherlock Fellowship; Medical Research Council (MRC); National Institute on Alcohol Abuse and Alcoholism (NIAAA); NIHR Newcastle Biomedical Research Centre

There are described the modern approaches to the classification, making a diagnosis, diagnostics and treatment of dysfunction of the biliary system. The effectiveness of conservative treatment of dysfunctions is marked., Изложены современные подходы к классификации, формулировке диагноза, диагностике и лечению дисфункции билиарной системы. Отмечена эффективность консервативной терапии дисфункций., Викладено сучасні підходи до класифікації, формулювання діагнозу, діагностики та лікування дисфункції жовчного міхура та сфінктера Одді. Наголошено на ефективності консервативної терапії дисфункцій.

Eosinophilic gastroenteritis is an uncommon disease characterized by eosinophilic infiltration of the gastrointestinal tract. The clinical manifestations are related to the layer(s) and extent of the bowel involved. In this paper, we present a case of intractable abdominal pain caused by jejunal submucosal eosinophilic infiltration without mucosal involvement, diagnosed by deep endoscopic biopsies. The patient was successfully treated with steroids without need for surgery for diagnosis or therapy. © 2014 S. Karger AG, Basel., NA

The article deals with the problem of anxiety and depressive disorders in patients with persistent gastroenterological symptomatology. According to HADS the average level of anxiety in examined patients was (11.20 ± 3.03), which corresponds to clinically significant categories, by scale of depression (9.20 ± 3.61) — to subclinical one. Personal high anxiety had 62.5 %, and high reactive anxiety — 65.6 % of patients. Objectification of anxiety and depressive disorders enable the reasonable approach to the choice of therapy., Статья посвящена проблеме тревожно-депрессивных расстройств у больных со стойкой гастроэнтерологической симптоматикой. По шкале HADS средний уровень тревоги у обследованных пациентов составил (11,20 ± 3,03), что соответствует клинически выраженной категории, а по шкале депрессии (9,20 ± 3,61) — субклинической. Персональную высокую тревожность имели 62,5 %, а реактивную высокую тревожность — 65,6 % больных. Объективизация тревожно-депрессивных расстройств позволяет обоснованно подходить к выбору терапии., Стаття присвячена проблемі тривожно-депресивних розладів у хворих зі стійкою гастроентерологічною симптоматикою. За шкалою HADS середній рівень тривоги в обстежених пацієнтів склав (11,20 ± 3,03), що відповідає клінічно вираженій категорії, а за шкалою депресії (9,20 ± 3,61) — субклінічній. Персональну високу тривожність мали 62,5 %, а реактивну високу тривожність — 65,6 % хворих. Об’єктивізація тривожно-депресивних розладів дозволяє обґрунтовано підходити до вибору терапії.

Transcatheter arterial embolization (TAB) and transcatheter arterial infusion (TAI) using cisplatin suspended in Lipiodol® Ultra-Fluide (Cisplatin/Lipiodol) are considered to be useful tumor-targeting therapies for hepatocellular carcinoma. However, little information is available on adverse events due to injection of Cisplatin/Lipiodol because the combined use Lipiodol and Cisplatin has not been approved by the Japanese government yet. Upon investigating the frequency and time of onset of adverse events following injection of Cisplatin/Lipiodol in 16 in-patients at Mie University Hospital, the frequency of the subjective symptoms of stomachache including epigastrium ache (75.0%), nausea or vomiting (50.0%), fever (50.0%), and gastric region discomfort (37.5%) was observed to be high. Further, leucocytes and neutrophils increased 2 days after injection (p< 0.001) and the onset of thrombocytopenia was much earlier than that following injection of Cisplatin alone. Severe adverse events defined as grade 3 or 4 in the Common Toxicity Criteria for Adverse Events Version 3.0 (JCOG/JSCO version, National Cancer Institute) were observed in 12 patients. These results suggest that great caution should be exercised with respect to adverse events occurring during Cisplatin/Lipiodol therapy.

Identifying autoimmune hepatitis as the etiology of acute liver failure (ALF) is potentially important, because administering corticosteroids might avoid the need for liver transplantation. However, clinical and histological criteria of autoimmune ALF (AI-ALF) have not been defined. Liver sections (biopsies and explants) from a 72-patient subset of the ALF Study Group Registry with indeterminate ALF were reviewed by a pathologist blinded to all clinical data and were diagnosed with probable AI-ALF based on four features suggestive of an autoi mmune pathogenesis: distinctive patterns of massive hepatic necrosis (present in 42% of sections), presence of lymphoid follicles (32%), a plasma cell???enriched inflammatory infiltrate (63%), and central perivenulitis (65%). Forty-two sections (58%) were considered probable for AI-ALF; this group demonstrated higher serum globulins (3.7 ?? 0.2 g/dL versus 3.0 ?? 0.2 g/dL; P = 0.037) and a higher prevalence of antinuclear and/or anti???smooth muscle antibodies (73% versus 48%; P = 0.034) compared to those without histology suggestive of probable AI-ALF. Thirty patients concordant for autoantibodies and probable AI-ALF upon histological analysis were more likely to have the classical autoimmune hepatitis phenotype (female predominance [72% versus 48%; P < 0.05], higher globulins [3.9 ?? 0.2 g/dL versus 3.0 ?? 0.2 g/dL; P < 0.005], and higher incidence of chronic hepatitis in long-term follow-up [67% versus 17%, P = 0.019]) compared to the population without concordant AI-ALF histology and autoantibodies. Conclusion: Patients with indeterminate ALF often have features of autoimmune disease by histological analysis, serological testing, and clinical recurrence during follow-up. In contrast to classical autoimmune hepatitis, histological features of AI-ALF predominate in the centrilobular zone. (H EPATOLOGY 2011;53:517-526)

In the CT26 BALB/c murine model of colorectal carcinoma, depletion of regulatory T cells (Tregs) prior to tumor inoculation results in protective immunity to both CT26 and other BALB/c-derived tumors of diverse histological origin. In this paper, we show that cross-protection can be conferred by adoptively transferred CD8(+) CTLs. Other schedules for inducing immunity to CT26 have been described, but they do not lead to cross-protection. We show that Treg ablation facilitates the development of new CTL specificities that are normally cryptic, and have mapped the root epitope of one of these responses. This work has allowed us to demonstrate how the specificity of CTL responses to tumor Ags can be controlled via differential suppression of CTL specificities by Tregs, and how this can result in very different physiological outcomes.

Mutations of LAMB2 typically cause autosomal recessive Pierson syndrome, a disorder characterized by congenital nephrotic syndrome, ocular and neurologic abnormalities, but may occasionally be associated with milder or oligosymptomatic disease variants. LAMB2 encodes the basement membrane protein laminin ??2, which is incorporated in specific heterotrimeric laminin isoforms and has an expression pattern corresponding to the pattern of organ manifestations in Pierson syndrome. Herein we review all previously reported and several novel LAMB2 mutations in relation to the associated phenotype in patients from 39 unrelated families. The majority of disease-causing LAMB2 mutations are truncating, consistent with the hypothesis that loss of laminin ??2 function is the molecular basis of Pierson syndrome. Although truncating mutations are distributed across the entire gene, missense mutations are clearly clustered in the N-terminal LN domain, which is important for intermolecular interactions. There is an association of missense mutations and small in frame deletions with a higher mean age at onset of renal disease and with absence of neurologic abnormalities, thus suggesting that at least some of these may represent hypomorphic alleles. Nevertheless, genotype alone does not appear to explain the full range of clinical variability, and therefore hitherto unidentified modifiers are likely to exist. Hum Mutat 31:992???1002, 2010. ?? 2010 Wiley-Liss, Inc.

Previous economic studies of Helicobacter pylori eradication in dyspepsia and peptic ulcer disease have not measured quality of life using utilities (preference probabilities), which are needed to compare the cost-effectiveness of such treatment to other health care interventions. The goals of this study were to measure quality of life in patients with dyspepsia or peptic ulcer and apply these measurements to published models of disease management to determine cost-effectiveness in dollars per quality-adjusted life year (QALY) gained. Methods : Utilities for dyspepsia and peptic ulcer disease were measured in adult patients (n = 73) on chronic acid suppression for peptic ulcer or ulcer-like dyspepsia. Median utility values were applied to the results of published cost-effectiveness analyses and a previously validated dyspepsia model. Cost-utility ratios for early H. pylori eradication in uninvestigated dyspepsia and peptic ulcer disease were then computed. Results : The total disutility, or lost quality of life, for an ulcer was 0.11 QALY, of which 0.09 QALY was attributed to dyspeptic symptoms. After these results were incorporated into published studies, cost-utility ratios for ulcer treatment varied from $3,100 to $12,500 per QALY gained, whereas estimates for uninvestigated dyspepsia management ranged from $26,800 to $59,400 per QALY. Sensitivity analyses indicated a range of $1,300 to $27,300 per QALY for management of duodenal ulcer and $15,000 to $129,700 per QALY for dyspepsia. Conclusions: Strategies that emphasize early H. pylori eradication were cost-effective for patients with peptic ulcer and possibly cost-effective for patients with uninvestigated dyspepsia, relative to other medical interventions. Dyspeptic symptoms cause significant disutility that should be incorporated in future cost-effectiveness analyses of treatment strategies.

Esophageal atresia (EA), a common congenital anomaly comprising interrupted esophagus with or without a tracheoesophageal fistula (TEF), affects one in 2840 newborns. Over half have associated anomalies. After EA repair in infancy, gastroesophageal reflux (GER) and esophageal dysmotility and respiratory problems are common. As there exist no previous population-based long-term follow-up-studies on EA, its long-term sequelae are unclear. The aims of this study were to assess the cancer incidence (I), esophageal morbidity and function (II), respiratory morbidity (III), and the spinal defects (IV) in adults with repaired EA. All patients treated for EA at the Hospital for Children and Adolescents, University of Helsinki, from 1947 to 1985 were identified, and those alive with their native esophagus were contacted, and the first hundred who replied made up the study group. The patients were interviewed, they filled in symptom questionnaires, and they underwent esophageal endoscopy and manometry, pulmonary function tests, and a full orthopedic evaluation was performed with radiographs of the spine. The questionnaire was also sent by mail to adults with repaired EA not attending the clinical study, and to 287 general population-derived controls matched for age, gender, and municipality of residence. Incidence of cancer among the study population was evaluated from the population-based countrywide cancer registry. 169 (72%) adults with repaired EA replied; 101 (42%) (58 male) participated in the clinical studies at a median age of 36 years (range, 22-56). Symptomatic GER occurred in 34% and dysphagia in 85% of the patients and in 8% and 2% of the controls (P<0.001 for both). The main endoscopic findings included hiatal hernia (28%), Barrett´s esophagus (11%), esophagitis (8%), and stenotic anastomosis (8%). Histology revealed esophagitis in 25 individuals, and epithelial metaplasia in another 21. At immunohistochemistry, CDX2-positive columnar epithelial metaplasia was pre, Väitöstutkimuksella uutta tietoa ruokatorven synnynnäisen puutoksen myöhäisvaikutuksista Puolivuosisataa ruokatorvikorjausleikkauksia Suomessa Väitöstutkimus selvitti ruokatorven synnynnäisen puutoksen myöhäisvaikutuksia. Ruokatorven synnynnäinen puutos eli ruokatorviatresia on melko yleinen ruokatorven synnynnäinen kehityshäiriö, jossa ruokatorven yläosa muodostaa umpipussin, ja lisäksi ruokatorven ja henkitorven välillä on yleensä yhdyskanava. Suomessa syntyy vuosittain noin 20 ruokatorviatresia-lasta. Yli puolella on lisäksi jokin muu kehityshäiriö. Ensimmäiset onnistuneet ruokatorviatresian korjausleikkaukset tehtiin Suomessa vuonna 1947. Vanhimmat potilaat lähestyvät kuudenkymmenen vuoden ikää. Mahanesteen takaisinvirtaus ruokatorveen ja ruokatorven toimintahäiriöt sekä hengitystieongelmat ovat tavallisia ongelmia lapsuudessa ruokatorviatresian korjausleikkauksen jälkeen. Aiheesta ei ole aiemmin tehty väestöpohjaisia pitkäaikais-seurantatutkimuksia, joten pitkäaikaisvaikutuksista ei ole aiempaa luotettavaa tietoa. Tutkimukseen otettiin mukaan vuosien 1947 ja 1985 välillä syntyneet Lastenklinikalla ruokatorviatresian vuoksi hoidetut henkilöt. Oirekyselykaavakkeet lähetettiin kaikille ja kliinisiin tutkimuksiin otettiin mukaan sata henkilöä. Kyselykaavakkeet lähetettiin postikyselynä myös väestörekisteristä satunnaisesti poimituille vertailuhenkilöille. Ensimmäisessä osatyössä selvitettiin syövän esiintymistä ruokatorviatresian korjauksen jälkeen yhteistyössä Syöpärekisterin kanssa. Yhtään ruokatorvisyöpää ei todettu. Syövän esiintymisessä yleensä ei ollut eroa keskivertoväestöön verrattuna. Toisessa osatyössä selvitettiin ruokatorviperäistä sairastavuutta ja ruokatorven toimintaa aikuisiällä ruokatorviatresian korjauksen jälkeen. Merkittäviä mahanesteen takaisinvirtausoireita eli gastroesofageaalista refluksia oli yli kolmasosalla ja nielemisvaikeuksia oli valtaosalla potilaista, kun vertailuhenkilöillä niitä esiintyi merkittävästi vähemmän. Ruokatorven tähystyk

Dietary vitamin A is an essential precursor of tissue retinol, which participates in a variety of biological processes including innate immunity. Functions of vitamin A mainly depend on retinoic acid（ RA）, principally all-trans- RA （atRA） and 9-cis-RA. We assessed whether atRA is benefi cial in host resistance against bacterial infections or not. Vitamin A-defi cient（ VAD） mice were highly susceptible to infection with Listeria monocytogenes. Pre-treatment with atRA enhanced host resistance against L. monocytogenes infection in both VAD and VAS mice. Interferon（ IFN） -γ production in atRA pre-treated VAS mice was not higher compared with the control VAD mice. The eff ect of atRA was independent of T cells and B cells. The bactericidal activity in macrophages obtained from atRA pre-treated VAS mice was almost the same level compared with the control VAS mice. Our results demonstrated that the treatment with atRA is benefi cial for host resistance against L. monocytogenes infection in the early phase and suggested a new therapeutic possibility of atRA in bacterial infections.